MEDICARE: DR. MONA MARLYNN SHANGOLD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	MD-043719-E	PA

General Provider Information

NPI Number	:	1457313389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MONA MARLYNN SHANGOLD M.D.

Provider Business Mailing Address
First Line	:	PO BOX 306
Second Line	:	SUITE 1200
City	:	MOORESTOWN
State	:	NJ
Zip	:	08057-0306
Country	:	US
Telephone Number	:	609-923-1691
Fax Number	:	856-273-7871

Provider Business Practice Location Address
First Line	:	1601 WALNUT ST
Second Line	:	SUITE 1200
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-2944
Country	:	US
Telephone Number	:	215-851-0999
Fax Number	:	215-851-0996

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	06/16/2016

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